High nerve injury pain predicts upper extremity disability

In brief

  • Patients who seek medical help at least six months after an upper extremity nerve injury also report a considerable level of disability that is associated, in part, with chronic pain.
  • Being older and having a brachial plexus injury also predict greater disability.

Why was this study done?

When people suffer nerve injuries of the shoulder, arm and hand, their degree of recovery is usually based on tests measuring their functioning. These tests measure how they feel and move (their sensory and motor functions). Patients’ own accounts of how well they are doing are not usually assessed. This study aimed to learn more about self-reports of health and well-being among patients with upper extremity nerve injuries, and to find out if these reports predicted greater disability.

How was the study done?

The researchers reviewed the medical charts of 85 adult patients who had seen a nerve surgeon six months or more after suffering an upper extremity nerve injury. Patients had filled out two questionnaires during their first visit to the surgeon. One asked about their general physical and mental health, including their pain levels (Short Form-36 questionnaire). The other assessed their degree of upper extremity disability (Disabilities of the Arm, Shoulder and Hand, or DASH, questionnaire). Combined with information about patients’ age, gender, nature of injury and other factors, researchers determined if and how patients’ reported health status was related to their reported degree of disability.

What did the researchers find?

Among nerve-injured patients, substantial long-term disability (with a high DASH score) was predicted by:

  • higher pain levels (on the SF-36)
  • older age, and/or
  • brachial plexus injury (the stretching or tearing of nerves that usually occurs when the shoulder is forcefully pressed down and away from the head).

Higher bodily pain on the SF-36 was the biggest predictor of greater disability.

What are some strengths and weaknesses of the study?

This study is one of the first to look at the predictors of disability in patients with upper extremity nerve injury. The main weakness of this study is its retrospective study design (i.e. looking back) and the limitations related to the data in the medical charts. Future prospective studies (following patients from a point in time onward) will evaluate the biomedical and psychosocial factors associated with pain and disability in patients with traumatic upper extremity nerve injury.

Publication Information

Title: 

Patient-reported outcome after peripheral nerve injury

Author(s): 

Novak CB, Dimitri JA, Beaton D, Katz J

Journal: 

Journal of Hand Surgery, 2009: vol. 34A, pp. 281-287